Debate over hyperbaric oxygen therapy for TBI and PTSD surfaces as VA urges caution
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Summary
Lawmakers backed a pilot to test hyperbaric oxygen therapy (HBOT) for veterans with traumatic brain injury (TBI) and PTSD, citing recent studies and patient demand; Department of Veterans Affairs witnesses said the evidence remains insufficient and raised safety and funding concerns.
Supporters of HR 1336, the Veterans National Traumatic Brain Injury Treatment Act, told the House Veterans' Affairs Subcommittee on Health they want a five‑year pilot to provide hyperbaric oxygen therapy (HBOT) to veterans with persistent TBI and PTSD symptoms.
"This is not only a viable, but a very, very successful intervention," Representative Tim Murphy said in opening remarks, referencing NIH meta‑analyses and veteran advocates. Emergency physician and hyperbaric specialist Dr. Andrew Kosminski, who testified for proponents, described clinical studies that showed neuropsychiatric improvements and said safety protocols are well established at accredited centers. "Establishing a pilot program for the VA to offer HBO therapy for veterans with TBIs and PTSD could help improve these patients' quality of life," Kosminski testified.
The nut graf: VA officials and VA‑affiliated experts warned the committee the agency's scientific review does not currently support HBOT for TBI or PTSD. Doctor Thomas O'Toole, VA deputy assistant undersecretary, told the committee the department "does not support this bill due to the lack of scientific evidence supporting HBOT for these conditions" and raised concerns about the proposed funding mechanism.
Committee members and witnesses debated the evidence base and safety oversight. Opponents pointed to VA and Department of Defense reviews that found HBOT outcomes comparable to placebo, while proponents cited more recent randomized trials and ongoing NIH research, including larger trials showing sustained benefit at six months and extended‑treatment cohorts with greater improvement. Kosminski acknowledged oxygen‑toxicity seizure risk in TBI patients at about 1 in 50 but said accredited hyperbaric centers are trained to manage that complication.
Several members urged adding patient safety guardrails to any pilot. Representative Brownlee asked whether the pilot should require treatment at facilities accredited by the Undersea and Hyperbaric Medical Society; Dr. Kosminski agreed accreditation would improve patient safety. VA witnesses said they would provide alternatives and comparative research summaries and that current VA and DOD guidance does not recommend HBOT as standard care for TBI or PTSD.
Ending: The committee did not vote on HR 1336. Members signaled interest in further research and in building explicit safety and accreditation requirements into any pilot authorization.